Summer vacations have been cancelled. Weddings postponed. Even baseball — America’s favorite pastime — has been curtailed because of COVID-19.
Businesses remain shuttered, with job losses mounting across the nation. Deep dives in the stock market have jeopardized the retirement savings for millions of Americans. Grandparents can no longer hug their grandchildren — if they can see them at all— without fear of the virus. Families with small children are coping with canceled summer camps and the uncertainty of whether schools will re-open in the fall.
“There is a lot of loss out there,” said Alan Giordano, director of Outpatient Services at Penn Medicine Princeton House Behavioral Health. “Millions of people have lost their jobs, almost everyone has lost their normal routine, and obviously, the biggest loss has been the loss of life.”
Taken together, these experiences have thrust America into a protracted, multi-textured grief. And what’s more, the virus has altered the grieving process itself.
Ambiguous Loss
“There is no greater loss than the loss of a loved one, and even in the best of times, the grief can feel overwhelming,” said the Rev. Matt Rhodes, director of Religious Ministries at Penn Medicine Princeton Health.
Rituals like funerals, shivas and memorial celebrations can often help ease the pain associated with the death of a loved one and allow those left behind to begin healing.
But due to social distancing requirements to stem the spread of the virus, the pandemic has forced many people to change the way they say goodbye, complicating the grieving process, though making it no less important.
In the absence of rituals surrounding the dying — such as visiting the bedside, viewing the body and having a funeral — the picture of the experience has been rapidly transformed.
“People are being left to grieve apart at a time when they need to be together the most,” Rhodes said.
These unclear and uncertain experiences that many people are grappling with right now are referred to as “ambiguous losses.”
Coined by the researcher and educator Pauline Boss, PhD, the term is used to describe situations when the emotional and physical realities don't align.
For instance, when a loved one in the military goes missing and dies, their family members may still feel them as emotionally present even as they are physically absent. Or it could go the other way — for instance, the way in which families might experience the emotional absence of a patient with dementia who remains physically present but unable to interact.
With COVID-19 striking even healthy individuals and hospital policies limiting visitation, these experiences are magnified for many families.
“When an otherwise healthy enough person leaves home to go to the hospital, declines rapidly, and the loved one doesn't get to see them throughout that whole process, it creates something like ambiguous loss,” Rhodes said. “They are physically gone now as they are dead, but it still feels as though they are emotionally present because one has not had a way to observe their loss.”
Focus on What’s Possible
On a recent Friday morning, Rhodes led a small service in the healing garden at Princeton Medical Center to remember loved ones lost to COVID-19, celebrate those who survived and honor the remarkable efforts of physicians and staff.
As part of the program, guest speaker Lisa Martucci-Thibault thanked health care workers for their heroic efforts during the pandemic. Martucci-Thibault’s mother, Ruth Ann Martucci, was among the patients who died at PMC as a result of COVID-19 complications in April.
Later, Martucci-Thibault talked about not being able to hold a service for her mother after she passed.
“We would have had a celebration of her life at the church where I was raised,” she said.
Instead, she and her father along with her husband and daughter went to the cemetery and watched as her mother’s ashes were interred. There was no clergy member to offer prayers. No gathering afterward.
“It’s hard to find closure without these rituals,” said Lisa. “It was and continues to be a surreal time.”
In response to the pandemic, Brielle P. Rassler, M.S., a doctoral psychology intern at Princeton Health, collaborated with the Department of Religious Ministries to start a grief counseling program offering free services to families whose loved ones died of COVID at PMC. A team of 15 licensed mental health professionals volunteered to help.
“We all wanted to do something,” said Rassler, who is also studying to become a rabbi. “We wanted families to know that we care about them through their whole journey.”
In addition to providing counseling, Rassler officiated a funeral over Zoom that was attended by children, grandchildren, friends and family from at least five different states.
“There is so much because of the pandemic that is not possible,” Rassler said. “Yes, it is really devastating that we can’t give each other hugs in person, but I tell people to try not to focus so much on what’s not possible, focus on what is possible.”